Grading on a Curve

My previous post, an update on the investigation into deaths at Memorial Hospital during hurricane Katrina, elicited this comment from a reader, Carla:

It was not the district attorney who had these people arrested. It was attorney general of the State, Charles Foti, who had them arrested despite that they were not charged. He made a big grandstand about it saying they were murderers, much like Mike Nifong said the Duke lacrosses players were rapists. The atty. general can investigate pursuant to his powers under the Medicaid Fraud Act. Then he has to turn things over to the local district attorney. Now the district attorney has convened a grand jury to see if he can charge the nurses and doc. that the atty. general arrested. The local coroner says he cannot determine cause of death. May I suggest heat, lack of medical equipment, stress and failure of government. But not lack of care from those who chose to stay behind to help patients and did not leave until all patients were evacuated.

I stand corrected on referring to Charles Foti as district attorney, rather than Louisiana Attorney General. And I wholeheartedly agree that he may well have used the Memorial death case opportunistically for personal political gain: the shadow of Mike Nifong looms long, and politically ambitious prosecutors can destroy lives by abusing the power of their office.

In fact, almost everything about this case begs for dismissal — it is fraught with extraordinary circumstances which solicit quick judgment and counsel hasty condemnation. A raging storm roars through a fragile city long known for its vulnerability, frail aging levies its sole defense against certain disaster. A city flooded, its weakest citizens trapped in a hospital-turned-hellhole. Heroic doctors and desperate nurses battling impossible circumstances, tending to the sick and dying, utterly abandoned by corrupt, inept civil servants and emergency services overwhelmed and overtaxed. An Attorney General exploiting public horror at the trapped and hopeless, sacrificing valiant healers to the gods of political ambition and self-aggrandizement. We desperately want to avert our eyes in disgust, having witnessed yet another example of corrupt politicians and cynical civil servants. The news is old; heap scorn and hurry along; judge harshly and hastily dismiss; feel that self-righteous contempt which comforts the mind while killing the spirit.

Yet pause we must. This perfect storm of pathos and perfidy masks a simple question which we ignore at our peril:Did patients die by the hand of their healers?

We may never know that answer for certain — witnesses were few, bodies too decomposed to offer reliable forensic evidence of final moments spent in fetid darkness and fevered fear.

Yet disquieting voices whisper through the howling winds of cynical outrage and callous contempt. Media reports and court documents speak of doctors and nurses at the hospital overhearing discussion of mercy killing, and hear of a doctor willing to do it. An administrator and other hospital personnel hear of an evacuation plan which which leaves no living patient behind and speaks of lethal injection. A doctor is seen holding a handful of syringes, and nurses stop providing comfort measures and block access to the ward. The accused physician’s Curriculum Vitae mentions her attendance at a conference on physician-assisted suicide — a reference later removed from her current CV.

Now, perhaps none of this occurred, or was simply hearsay. Perhaps it was all talk and no action. Much of the investigation is still under wraps, and substantial information is as yet undisclosed. Yet it is striking how few — especially in the medical profession — even stop to consider that it may indeed have happened, choosing instead to embrace the narrative of heroic physicians persecuted by the politically ambitious.

Physicians are no strangers to abuses of power for political gain. The compliance enforcement for federal health programs exposes them to extraordinary penalties for failure to grasp its byzantine regulations and mind-numbing documentation standards. Even more relevant to this situation is the often-archaic suspicion of medical disciplinary boards — typically staffed by clueless political appointees — who view every physician managing chronic or terminal pain as an enabler of addicts. There is, of course, some substantial support for euthanasia among physicians (and even more so in the population at large) — and thus these see no reason to find such action, had it occurred, unethical or reprehensible in any way.

But perhaps most importantly, both among physicians and in our culture at large, there is a sense of moral incrementalism, a relativism deeply ingrained, that context rules conscience, that particulars trump principles. Our culture is bathed in shades of gray. From the severe social strictures of multiculturalism, where no group may be criticized nor culture condemned; to situation ethics, in school and the workplace; to postmodern education, where no truth exists and all narratives are valid; to media where terrorists become “insurgents” and fascists “reformers” — there exists no longer a language of principle, no words for right or wrong, no common ground to condemn that which is reprehensible. We have lost our compass; no more are actions measured against absolutes, or practices judged by principles. We grade on a curve — and everyone passes. Who are we, after all, to judge? Your values are fine for you, but not for me — for they are, in the end, only your values.

The Memorial case may well prove empty, another unscrupulous prosecutor destroying lives for personal gain. Judgment of the accused may well raise suspicions, yet fail to meet the legal standards for conviction.

Yet however they are judged, we have already been judged — by our indifference to the consequences of creeping dissolution, by consciences made too comfortable by compromise and corruption, by malleable morals and inconstant integrity.

Will we recognize great evil when it comes upon us? Or will we, instead, greet it as an old companion, comfortable and familiar — and wonder why we no longer have a solid foundation on which to stand, as foul waters rise strong around us?

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8 thoughts on “Grading on a Curve”

And I wholeheartedly agree that he may well have used the Memorial death case opportunistically for personal political gain: the shadow of Mike Nifong looms long, and politically ambitious prosecutors can destroy lives by abusing the power of their office.

Kudos for recognizing that prosecutorial abuse is not limited to lacrosse players, and care should be taken in matters prosecutorial.

At the same time, the cases aren’t the same. Here there may be reasonable doubt, but as you point out there is substantial ground for suspicion, and more for concern about the ethical question involved.

If these are just moribund hunks of protoplasm, post-fetuses if you will, why not spare them and ourselves the pain and annoyance of their puling and moaning?

I have asked myself how I would prefer to die, if I were old or just very, very ill; helpless, defenseless and trapped with no possibility of rescue. Would I prefer that someone who has sworn to “do no harm” give me a lethal injection, or to be left to die more gradually from flooding, loss of power (including no oxygen), lack of nutrition and drinkable water, or any of the other conditions that those people would have been left to? I dearly hope I will never be in such a position, but I suspect I would prefer the prick of a needle. If that shows me to be a royal coward, then I confess to being a coward. I can’t speak for God, but I have trouble imagining He would judge harshly any “mercy killings,” under those conditions.

I understand well what you are saying — my wife and mother-in-law have expressed similar thoughts. It is a natural desire (and a good one) to wish an easy out rather than than a painful exit — a demise which we all desire.

The Christian answer is that this is not our choice to make — a position which seems cruel and unreasonable to many (even myself at times).

The answer, I believe, lies in the focus: it is entirely on us, on our wishes, desires, and comfort. This is not wrong, but ignores the real threat: giving the power to make that decision to another man, who does not have the wisdom and moral purity to make such a decision, rather than leaving it with God, whose wisdom is perfect — and who can use suffering and death for far greater good (though death and suffering are themselves evil) than we can foresee and imagine.

However strong (and reasonable) your desire for a painless death, do not give this power to your doctor. You will unleash an unimaginable holocaust.

Thank you for such a thoughtful reply…not that I would expect anything less from you.

I knew as I was leaving my comment that I was not expressing the Christian answer, or displaying faith in the One who is wisdom, itself. But at a thoroughly human, gutteral level, it would probably be my answer under such conditions as existed in New Orleans. (Since I live in the Sonoran desert, that isn’t likely!)

Otherwise, I would ask for the faith to die a natural death, even the one that is painful, uncomfortable or slow. Mind you, I would probably be praying for God to take me sooner, rather than later, as my late mother-in-law did and I suspect my mom is.

So what is the motive? People were being evacuated. The docs and nurses could have left their patients like Bryant King did. The caregivers at Memorial did not stop being caregivers because of the storm. Foti is a freak driven by CNN. The people at Memorial are heroes. This whole thing is so much media hype and Foti thinks he will be re-elected. Everyone who knows someone who worked in the hospitals during the storm knows they did their jobs like they have always done during storms. Your speculation is only that. You were not there.

Ellen, I wasn’t there, either. But in my hypothetical scenario, I was imagining being one of those patients who had no hope of escape or rescue, who could not get up and walk out on my own, who was perhaps terminally ill, already; were there any good options? The flood waters would come in. Would they stop rising before drowning the patients? Would the patients die from the heat with no air conditioning, or from the lack of oxygen because sources of oxygen require power? If, instead of being a patient, I am a caregiver–doctor, nurse, aide, whatever–and I walk away, leaving them there, what kind of nightmares do I have, and for how long, about the kinds of deaths the patients experienced? And before death, the fears. How loudly did the patients call for help, if they were able?

Dr. Bob, I understand what you’ve said about doctors having the power to make the decision to end life. I do hear that, and I agree. But what about the other option, in a horrible situation like Katrina? Was it as bad as I imagine it? Worse? Were there any good options?

If Foti turns out to be a “freak”, an out-of-control prosecutor, and none of this happened, I’ll shrug my shoulders, admit my concerns were misplaced, and move on.

If, however, the opposite occurs — if evidence is compelling that Pou actively terminated patients, with the help of others, I strongly suspect you will never believe it. Your narrative seems frozen in stone, and highly unlikely to be altered by contrary facts. We’re all entitled to our opinions, of course — but I have to wonder whether your vehement reaction to the possibility that it may have happened masks an unwillingness to accept that it could have happened.

The reality is likely to end up ambivalent, with no definitive answer, so I suspect you will be able to maintain your comfortable certainty about what happened there.

As someone who lived through the storm and someone who knows people at Memorial, let me say that there is a collective sigh of relief that the grand jury declined to press charges. Even if they had, it was unlikely you were going to find 12 people in Orleans Parish who would have been able to pass judgement on Dr Pou and the nurses. Unless you lived through that time, you can’t understand what we went through. We all had to make tough decisions under the most horrible conditions imaginable.